Scientific Online Resource System

Bulgarian Review of Ophthalmology

Bromfenac 0.09% ophthalmic solution for postoperative pain and ocular discomfort after cataract surgery with phacoemulsification

Jana Simova, Mladena Radeva, Dimitar Grupchev, Christina Grupcheva



The aim of this article is to study the effect of bromfenac 0.09% ocular solution on postoperative pain and other ocular symptoms after cataract surgery.


Sixty-one eyes of 51 patients undergoing uneventful cataract surgery with phacoemulsification technique were randomized to tobramycin 3 mg/mL-dexamethasone 1 mg/mL ophthalmic solution or with the adjunct of bromfenac 0.09% ophthalmic solution. All patients completed a questionnaire about pain and other ocular symptoms at baseline and at 3 postoperative visits. Statistical analysis was performed using SPSS statistics software package (v22.0) for Windows (IBM SPSS Inc., Chicago, IL,). On account of lack of normal distribution, a nonparametric analysis was conducted. Variables were compared by their medians and the null hypothesis was tested with a confidence level of 95% (CI=95%).


On the first postoperative day 68.6 % of controls assessed their vision as ‘good` or better, while in the test group 80.8% chose ‘very good` and ‘excellent` from the questionnaire. A week later, the mean rank for vision was significantly higher for the treatment group compared to the control group and despite the proportion remaining similar by the end of the follow-up period, the difference was not found to be statistically significant. On day 1, 88.6% of the control group and 92.3% of the treatment group stated that their vision was stable always or most of the time (p=0.05).


Bromfenac 0.09% ophthalmic solution in addition to standard postoperative topical treatment showed to be effective not only in alleviating ocular discomfort after uneventful cataract surgery, but in faster achievement of stability of refraction and overall visual function. The successful surgical outcome is not restricted only to a well-performed safe cataract removal, leading to the optimal refractive and visual result, it is also of significant importance to provide a painless, comfortable and satisfying postoperative period for the patient. This means that every therapeutic option, which can contribute to achieving this goal should be considered as long as it poses no risk.


cataract surgery; phacoemulsification; NSAIDs; follow-up study; recovery

Full Text


Swenor BK, Simonsick EM, Ferrucci L, Newman AB, Rubin S, Wilson V. Visual impairment and incident mobility limitations: The health ABC study. J Am Geriatr Soc. 2015;63(1):46-54. doi: 10.1111/jgs.13183.

Beaton K, McEvoy C, Grimmer K. Identifying indicators of early functional decline in community-dwelling older people: a review. Geriatr Gerontol Int. 2015;15(2):133-40. doi: 10.1111/ggi.12379.

Pan C-W, Liu H, Sun H-P, Xu Y. Increased difficulties in managing stairs in visually impaired older adults: A community-based survey. PLoS ONE. 2015;10(11):e0142516. doi: 10.1371/journal.pone.0142516.

Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96(5):614-8. doi: 10.1136/bjophthalmol-2011-300539.

Pizzarello L, Abiose A, Ffytche T, Duerksen R, Thulasiraj R, Taylor H, et al. VISION 2020: The Right to Sight: A global initiative to eliminate avoidable blindness. Arch Ophthalmol. 2004;122(4):615-20. doi: 10.1001/archopht.122.4.615.

Blindness and visual impairment [Internet]. World Health Organization. [cited 2018 Oct 10]. Available from:

Zhao L, Chen X-J, Zhu J, Xi Y-B, Yang X, Hu L-D, et al. Lanosterol reverses protein aggregation in cataracts. Nature. 2015;523(7562):607-11. doi: 10.1038/nature14650.

Hejtmancik JF. Ophthalmology: Cataracts dissolved. Nature. 2015;523(7562):540-1. doi: 10.1038/nature14629.

Babizhayev MA, Deyev AI, Yermakova VN, Semiletov YA, Davydova NG, Kurysheva NI, et al. N-Acetylcarnosine, a natural histidine-containing dipeptide, as a potent ophthalmic drug in treatment of human cataracts. Peptides. 2001;22(6):979-94.

Comstock TL, Decory HH. Advances in corticosteroid therapy for ocular inflammation: loteprednol etabonate. Int J Inflam. 2012;2012:789623. doi: 10.1155/2012/789623.

Tang Y, Wang X, Wang J, Huang W, Gao Y, Luo Y, et al. Prevalence of age-related cataract and cataract surgery in a Chinese adult population: The Taizhou Eye Study. Invest Ophthalmol Vis Sci. 2016;57(3):1193-200. doi: 10.1167/iovs.15-18380.

Daien V, Le Pape A, Heve D, Carriere I, Villain M. Incidence and characteristics of cataract surgery in France from 2009 to 2012. Ophthalmology. 2015;122(8):1633-8.

Koo E, Chang JR, Agrón E, Clemons TE, Sperduto RD, Ferris FL, et al. Ten-year incidence rates of age-related cataract in the Age-Related Eye Disease Study (AREDS): AREDS report no. 33. Ophthalmic Epidemiol. 2013;20(2):71-81.

Lundstrom M, Stenevi U, Thorburn W. The Swedish National Cataract Register: A 9-year review. Acta Ophthalmologica Scandinavica. 2002;80(3):248-57. doi: 10.1016/j.ophtha.2015.04.017.

Behndig A, Montan P, Stenevi U, Kugelberg M, Lundström M. One million cataract surgeries: Swedish National Cataract Register 1992-2009. J Cataract Refract Surg. 2011;37(8):1539-45. doi: 10.1016/j.jcrs.2011.05.021.

Klein BE, Klein R, Moss SE. Incident cataract surgery: the Beaver Dam eye study. Ophthalmology. 1997;104(4):573-80.

Gollogly HE, Hodge DO, St. Sauver JL, Erie JC. Increasing incidence of cataract surgery: Population-based study. J Cataract Refract Surg. 2013;39(9):1383-9.

Surgical operations and procedures statistics - Statistics Explained [Internet]. [cited 2018 Jul 28]. Available from:

Gonzalez-Salinas R, Guarnieri A, Guirao Navarro MC, Saenz-de-Viteri M. Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac. Patient Prefer Adherence. 2016;10:1795-801. doi: 10.2147/PPA.S90468.

Alio JL, Grzybowski A, El AA, Romaniuk D. Refractive lens exchange. Surv Ophthalmol. 2014;59(6):579-98. doi: 10.1016/j.survophthal.2014.04.004.

Day AC, Donachie PHJ, Sparrow JM, Johnston RL, Royal College of Ophthalmologists` National Ophthalmology Database. The Royal College of Ophthalmologists` National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications. Eye (Lond). 2015;29(4):552-60. doi: 10.1038/eye.2015.3.

Kim SJ, Schoenberger SD, Thorne JE, Ehlers JP, Yeh S, Bakri SJ. Topical nonsteroidal anti-inflammatory drugs and cataract surgery: A report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(11):2159-68. doi: 10.1016/j.ophtha.2015.05.014.

Mohammadi S-F, Hashemi H, Mazouri A, Rahman-A N, Ashrafi E, Mehrjardi HZ, et al. Outcomes of cataract surgery at a referral center. J Ophthalmic Vis Res. 2015;10(3):250-6. doi: 10.4103/2008-322X.170358.

Porela-Tiihonen S, Kaarniranta K, Kokki M, Purhonen S, Kokki H. A prospective study on postoperative pain after cataract surgery. Clin Ophthalmol. 2013;7:1429-35. doi: 10.2147/OPTH.S47576.

Mohan N, Gupta V, Tandon R, Gupta SK, Vajpayee RB. Topical ciprofloxacin-dexamethasone combination therapy after cataract surgery: randomized controlled clinical trial. J Cataract Refract Surg. 2001;27(12):1975-8.

Pianini V, Passani A, Rossi GCM, Passani F. Efficacy and safety of netilmycin/dexamethasone preservative-free and tobramycin/dexamethasone-preserved fixed combination in patients after cataract surgery. J Ocul Pharmacol Ther. 2010;26(6):617-21. doi: 10.1089/jop.2010.0050.

Camesasca FI, Bianchi C, Beltrame G, Caporossi A, Piovella M, Rapisarda A, et al. Control of inflammation and prophylaxis of endophthalmitis after cataract surgery: a multicenter study. Eur J Ophthalmol. 2007;17(5):733-42.

Raizman MB, Donnenfeld ED, Weinstein AJ. Clinical comparison of two topical prednisolone acetate 1% formulations in reducing inflammation after cataract surgery. Curr Med Res Opin. 2007;23(10):2325-31. doi: 10.1185/030079907X226195.

Donnenfeld ED, Holland EJ, Stewart RH, Gow JA, Grillone LR, Bromfenac Ophthalmic Solution 0.09% (Xibrom) Study Group. Bromfenac ophthalmic solution 0.09% (Xibrom) for postoperative ocular pain and inflammation. Ophthalmology. 2007;114(9):1653-62. doi: 10.1016/j.ophtha.2006.12.029.

Rajpal RK, Ross B, Rajpal SD, Hoang K. Bromfenac ophthalmic solution for the treatment of postoperative ocular pain and inflammation: safety, efficacy, and patient adherence. Patient Prefer Adherence. 2014;8:925-31. doi: 10.2147/PPA.S46667.

K O, Ohkuba A, Miyamoto T. Effect of bromfenac sodium on postoperative inflammation. Jpn J Catarac Refract Surg. 2004;18:1-12.

Takamatsu F, Shiroyama N, Saito Y. Efficacy and adverse effects of bromfenac ophthalmic solution following cataract surgery. Rinsho Ganka (Jpn J Clin Ophthalmol). 2003;57:1233-7.

Bucci FA, Waterbury LD. Comparison of ketorolac 0.4% and bromfenac 0.09% at trough dosing: aqueous drug absorption and prostaglandin E2 levels. J Cataract Refract Surg. 2008;34(9):1509-12. doi: 10.1016/j.jcrs.2008.05.023.

Silverstein SM, Cable MG, Sadri E, Peace JH, Fong R, Chandler SP, et al. Once daily dosing of bromfenac ophthalmic solution 0.09% for postoperative ocular inflammation and pain. Curr Med Res Opin. 2011;27(9):1693-703. doi: 10.1185/03007995.2011.597663.

Hoy SM. Bromfenac ophthalmic solution 0.07%: A review of its use after cataract surgery. Clin Drug Investig. 2015;35(8):525-9. doi: 10.1007/s40261-015-0309-3.

Du X, Zhao G, Wang Q, Yang X, Gao A, Lin J, et al. Preliminary study of the association between corneal histocytological changes and surgically induced astigmatism after phacoemulsification. BMC Ophthalmol. 2014;14:134. doi: 10.1186/1471-2415-14-134.

Rosenberg ME, Tervo TMT, Müller LJ, Moilanen JAO, Vesaluoma MH. In vivo confocal microscopy after herpes keratitis. Cornea. 2002;21(3):265-9.

Solomon A, Dursun D, Liu Z, Xie Y, Macri A, Pflugfelder SC. Pro- and anti-inflammatory forms of interleukin-1 in the tear fluid and conjunctiva of patients with dry-eye disease. Invest Ophthalmol Vis Sci. 2001;42(10):2283-92.

Funderburgh JL, Mann MM, Funderburgh ML. Keratocyte phenotype mediates proteoglycan structure: a role for fibroblasts in corneal fibrosis. J Biol Chem. 2003 Nov 14;278(46):45629-37. doi: 10.1074/jbc.M303292200.

Masuda K, Fukado Y, Shimizu H. Effect of bromfenac sodium ophthalmic solution on inflammation following intraocular lens implantation. Ganka Rinsho Iho (Jpn Rec Vin Ophthalmol). 1997;91:745-750.

Coassin M, Iovieno A, Soldani A, Cavuto S, Cimino L, Sartori A, et al. Bromfenac ophthalmic solution 0.09% as an adjunctive therapy to topical steroids after cataract surgery in pseudoexfoliation syndrome. J Cataract Refract Surg. 2016;42(8):1119-25. doi: 10.1016/j.jcrs.2016.04.031.

Donnenfeld ED, Nichamin LD, Hardten DR, Raizman MB, Trattler W, Rajpal RK, et al. Twice-daily, preservative-free ketorolac 0.45% for treatment of inflammation and pain after cataract surgery. Am J Ophthalmol. 2011r;151(3):420-426.e1. doi: 10.1016/j.ajo.2010.09.003.

Garg A. Ocular Therapeutics. JP Medical Ltd; 2013. 1106 p.

Colin J, Paquette B. Comparison of the analgesic efficacy and safety of nepafenac ophthalmic suspension compared with diclofenac ophthalmic solution for ocular pain and photophobia after excimer laser surgery: a phase II, randomized, double-masked trial. Clin Ther. 2006;28(4):527-36. doi: 10.1016/j.clinthera.2006.04.004.

Baiza-Duran LM, Quintana-Hau J, Tornero-Montaño R, Ortiz MI, Castañeda-Hernández G, Alanis-Villarreal L, et al. Comparison of the efficacy and safety of a novel meloxicam ophthalmic formulation with a reference diclofenac solution in cataract surgery. Int J Clin Pharmacol Ther. 2009 Feb;47(2):89-95.

Maxwell WA, Reiser HJ, Stewart RH, Cavanagh HD, Walters TR, Sager DP, et al. Nepafenac dosing frequency for ocular pain and inflammation associated with cataract surgery. J Ocul Pharmacol Ther. 2008;24(6):593-9. doi: 10.1089/jop.2008.0023.

Giannaccare G, Finzi A, Sebastiani S, Greco F, Versura P, Campos EC. The Comparative Efficacy and Tolerability of Diclofenac 0.1% and Bromfenac 0.09% Ophthalmic Solutions after Cataract Surgery. Curr Eye Res. 2018; 14:1-9. doi: 10.1080/02713683.2018.1501489.

Fong R, Leitritz M, Siou-Mermet R, Erb T. Loteprednol etabonate gel 0.5% for postoperative pain and inflammation after cataract surgery: results of a multicenter trial. Clin Ophthalmol. 2012;6:1113-24. doi: 10.2147/OPTH.S32643.

Hosseini K, Walters T, DaVanzo R, Lindstrom RL. A randomized double-masked study to compare the ocular safety, tolerability, and efficacy of bromfenac 0.075% compared with vehicle in cataract surgery subjects. Clin Ophthalmol. 2016; 10:2311-7. doi: 10.2147/OPTH.S120428.

Walters TR, Goldberg DF, Peace JH, Gow JA. Bromfenac Ophthalmic Solution 0.07% Once Daily Study Group. Bromfenac ophthalmic solution 0.07% dosed once daily for cataract surgery: results of 2 randomized controlled trials. Ophthalmology. 2014;121(1):25-33. doi: 10.1016/j.ophtha.2013.07.006.



Font Size

About The Authors

Jana Simova
Medical University of Varna

Department of Ophthalmology and Visual Sciences, Faculty of Medicine

Mladena Radeva
Medical University of Varna

Department of Ophthalmology and Visual Sciences, Faculty of Medicine

Dimitar Grupchev
Medical University of Varna

Department of Ophthalmology and Visual Sciences, Faculty of Medicine

Christina Grupcheva
Medical University of Varna

Department of Ophthalmology and Visual Sciences, Faculty of Medicine